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目的探讨下斜肌减弱手术后主观旋转的动态变化及其影响因素。设计回顾性病例系列。研究对象18例连续性入院行下斜肌减弱手术的V型斜视患者。方法对18例原发性或发病早期的继发性下斜肌功能亢进+2～+3的V征斜视患者,行双眼下斜肌减弱手术,观察术前,术后1天、2天、3天和1周的主观旋转症状;同时行双马氏杆(DMRT)检查第一眼位,上、下注视眼位的旋转度和同视机检查双眼视功能水平。主要指标下斜肌功能亢进程度,主观旋转度,主观旋转症状,双眼视功能状态。结果18例患者术前无主观旋转;术后打开敷料后1小时内均感双眼视物时内旋转,2小时后4例双眼视物旋转,6例单眼视物时旋转;术后2天、3天和1周时视物旋转者减少;术后1周时1例双眼视物时旋转,4例单眼视物时旋转;均为原主斜眼视物旋转;术后8例获得一定双眼视功能者无旋转症状。术后1天DMRT检查,14例内旋,术后2天、3天及1周时DMRT结果渐减小,术后1周时9例内旋;各注视眼位旋转度无明显差别。结论下斜肌减弱术后主观旋转是动态变化过程,术后有旋转症状者均为原主斜眼视物旋转,术后获得一定双眼视功能者能更早代偿旋转改变。(眼科,2008,17:123-126)
Objective To investigate the dynamic changes of subjective rotation after inferior oblique muscle weakening surgery and its influencing factors. Design retrospective case series. The study included 18 consecutive V-strabismus patients undergoing lower oblique surgery. Methods 18 cases of primary or early onset secondary hypoplastic hyperalgesia +2 to +3 V-strabismus patients underwent bilateral inferior oblique muscle weakening surgery were observed preoperative and postoperative 1 day, 2 days, 3 days and 1 week of subjective rotation symptoms; simultaneous dual Markov Rod (DMRT) check the first eye position, upper and lower eye rotation degree of attention and binocular visual function with the same level of inspection. Main indicators of oblique muscle function hyperthyroidism, subjective rotation, subjective rotation symptoms, binocular visual function status. Results There were no subjective rotations in 18 patients before operation. All eyes were rotated within 1 hour after opening the dressing, 4 eyes of two eyes were rotated in 2 hours and 6 eyes of eyes were rotated in 2 days after operation. 3 days and 1 week, the number of rotations decreased; one case of double-view was rotated 1 week after operation and 4 cases of single-view were rotated; No rotational symptoms. The results of DMRT examination at 1 day after operation, internal rotation of 14 cases, DMRT at 2 days, 3 days and 1 week after operation decreased gradually, and 9 cases rotated at 1 week after operation. There was no significant difference in rotation between fixation eyes. Conclusions Subjective rotation after inferior oblique muscle weakening is a dynamic process. After the rotation, all the patients with rotational symptoms are rotated by the original main oblique eye. After a certain binocular vision function, those with rotational symptoms can be compensated earlier. (Ophthalmology, 2008,17: 123-126)